Doctor to many, mother to three, wife to one. I run, I blog, I cross-stitch.

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C8H10N4O2

According to the Center for Addiction and Mental Health, it is the world’s most popular drug and most widely used psychoactive substance in the world. It is legal and unregulated in nearly all parts of the world. In its purest form, it is a white, bitter-tasting powder. It is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants, as well as enhancing the reward memory of pollinators. [References: Wikipedia]

It is very likely that most, if not all, of you reading this are consuming it right now.

Yes, I’m talking about caffeine. The elixir of Gods. My elixir.

I usually consume one to two cups (about 8oz) a day, but lately, that number is more like 3-4 cups. I can’t help it, it’s keeping me awake. Or so I think. So I decided to do a bit of research to see if it really does help keep us awake and more alert. A study released last month suggests that caffeine’s interaction with the hormone cortisol is key in its effects on the body. Apparently the best time to drink one’s cup of coffee is between 9:30-11:30am when our cortisol levels start to drop off. Cortisol is the body’s “awake” hormone, it helps to regulate the body’s own internal clock and promotes alertness. It peaks between 6-9am, right around the time we are waking up. According to neuroscientists, if we drink our coffee first thing in the morning when our cortisol levels are at their highest, it can cause you to develop a tolerance to the caffeine it contains, meaning you often need an extra shot in your morning cup to get the same effect.

I’m not suggesting that caffeine is good for you. Like with any psychoactive substance, too much can, and often is bad for you. So just how much is too much? And what’s so bad about it anyway? According to Health Canada, caffeine’s negative effects include:

Health Canada recommends no more that 400 mg of caffeine daily for most healthy adults. This number is lower for women who are trying to conceive. Motherisk’s statement on caffeine and pregnancy reports that daily consumption of no more than 300 mg of caffeine daily appears to be safe. Higher levels of caffeine consumption during the first trimester of pregnancy may be related to an increased risk of miscarriage.

The following are typical amounts of caffeine in products you may use regularly. (A cup refers to a small take-out cup size of 237 mL [8 oz]. Keep in mind that coffee and tea are often served in much larger cups.)

cup of brewed coffee: 135 mg

cup of instant coffee: 76–106 mg

cup of decaffeinated coffee: about 3 mg

cup of tea: 43 mg

can of regular cola soft drink containing caffeine (355 ml): 36–50 mg

can of energy drink (250 ml): 80 mg

dark chocolate (28 g): 19 mg

milk chocolate (28 g): 7 mg

packet of hot chocolate mix: 7 mg

stay-awake pills: 100 mg

What’s good about caffeine? You mean besides the taste? (Oh, I highly recommend a shot of Baileys in your morning coffee…. what?) Caffeine consumption is associated with an overall lower the risk of cancer, particularly liver and endometrial cancers; it may reduce the risk of type 2 diabetes; it may increase the effectiveness or certain medications, especially those used to treat headaches; it is the primary treatment for apnea of prematurity; and lets not forget that caffeine can increase alertness and overall, make you feel good. (Okay, I added that last bit.)

Of course, too much caffeine is bad for you. Caffeine intoxication is actually listed in the DSM 5! Caffeine toxicity, although rare, is quite harmful. Symptoms include restlessness, fidgeting, anxiety, excitement, insomnia, flushing of the face, increased urination, gastrointestinal disturbance, muscle twitching, a rambling flow of thought and speech, irritability, irregular or rapid heart beat, and psychomotor agitation. In cases of much larger overdoses, mania, depression, lapses in judgment, disorientation, disinhibition, delusions, hallucinations, or psychosis may occur, and rhabdomyolysis (breakdown of skeletal muscle tissue) can be provoked. Overdose can lead to death. The median lethal dose of caffeine in humans is estimated to be about 150-200 mg/kg body weight, which is equivalent to about 80-100 cups of coffee. Seriously? Who could drink that much coffee?

The bottom line is, like any other recreational drug (within reason, of course) moderation is the key.

I am an endurance athlete (distance cyclist) who has consumed (or more correctly, abused) caffeine for many years. Earlier this year my gastroenterologist convinced me to give up caffeine altogether (against my will). On the second day of my caffeine-free existence my wife started hiding all the sharp objects in our house and put 9-1-1 on speed dial! By the third day she was encouraging me to spend more time at the office. The headaches stopped by the the eighth or ninth day, but I sure miss that “elixir of gods.”

Thanks for the comment. Indeed, caffeine withdrawal was something I didn’t address. I too have had some brutal headaches only to realize I hadn’t gotten around to drinking my coffee. I don’t think I could ever truly give it up.

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Disclaimer

Any office scenarios described here have been altered to protect the patient's privacy. This blog is not intended to offer clinical advice. If you are concerned about your health, get off Dr. Google and please go see your doctor. Any similarity to any person living or dead is merely coincidental.

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